Needle and Transducer Manipulation: The Art of Ultrasound-guided Regional Anaesthesia

Successful regional anaesthesia can be summed up by the axiom “The right drug, in the right dose, in the right place”.1 The process of getting the drug to the right place has evolved from the routine elicitation of paraesthesia, to the use of peripheral nerve stimulation, and most recently, ultrasound (US) guidance. US guidance has revolutionised regional anaesthesia (or more specifically, peripheral nerve blockade (PNB)) because it is now possible to directly visualise nerves and their surrounding structures, the advancing needle, and the spread of local anaesthetic during injection. Yet even as the popularity of US-guided PNB grows, several reports have emerged of inadvertent neural or vascular puncture.2-5 Most of these can be ascribed to failure to fully appreciate the location of the needle tip during performance of the block. The objective of this article is to discuss the elements of needle and transducer handling that contributes to successful needle tip localisation during US-guided PNB.